Metro East Sun

Small-business owners complain the most about one particular aspect of workers' compensation legislation, the "causation" rule that effectively means if a pre-existing condition or injury is aggravated at work then the employee is covered, according to one candidate for the 54th District Senate seat.

In conversations with business owners, candidate George Barber said the feedback he is getting is that "causation" is much too loosely defined and that too much time and energy is spent dealing with its effects.

Illinois has a no-fault rule stating that if even 1 percent of an injury is linked to work, then the medical expenses are covered by workers' compensation. This has an impact on the amount in premiums employers pay.

Barber, one of four Republican candidates in the race to replace Sen. Kyle McCarter in the 54th District, told the Madison - St. Clair Record said he will work for changes if elected. 

The other candidates for the seat are Jason Plummer, a 2010 candidate for lieutenant governor, Benjamin Stratemeyer and Rafael Him.

Barber spoke following the publication of a report that revealed medical payments per workers' compensation grew more than 3 percent on average every year from 2012 to 2015.

"What I would say is I go around and meet with people and ask business owners 'What areas would you like to see reform?'" Barber said. "And people say you need to look at the workers' compensation and you need to consider it, especially causation."

Barber added, "These business owners argue it is too loosely defined spent a lot of time and energy dealing with the system."

Medical payments per workers' compensation claim Illinois grew 3.1 percent per year on average, according to the recent study by the Massachusetts-based Workers Compensation Research Institute (WCRI).

"In all, medical payments per workers’ compensation claim were higher in Illinois than the median for the states included in the study," the WCRI said.

"Recent public policy discussions in Illinois have focused on reducing workers’ compensation costs and making the state more attractive to businesses," WCRI Executive Vice President and Counsel Ramona Tanabe stated in the WCRI release. "Among the areas of interest are causation of the injury, medical fee schedules, insurance premiums and permanent partial disability benefits."

Tanabe told the Record: "The 3 percent annual average increase in medical cost per claim with more than seven days of lost time is similar to many study states. Half of the study states had 2-4 percent annual growth over the same time frame."

She added, "Regarding causation – the causation standard is the threshold at which a worker’s injuries are covered by the WC system. Different states have different standards, and the scope of coverage will therefore affect costs. This issue is important to all stakeholders."

The other candidates were not immediately available for comment, but Plummer has spoken in the past of the need for the reform of workers' compensation in the state.

Plummer, the vice president of his family's lumber company R.P. Lumber, is a member of the Home Builder Association of Greater Southwest Illinois, which has called for a change in the "causation" rule. 

Its members want any work-related injury or medical issue to be a "major cause" before an employee is eligible for workers' compensation. Others, including Gov. Bruce Rauner, have argued for a specific 50 percent threshold to be introduced.

The association also wants changes to the medical fee schedule, which it claims is 19 percent to 45 percent higher than other states.

Barber has his own experience of workers' compensation as he has to provide it when he runs a small summer basketball camp.

"It is so confusing that I need a person to help me, someone who works for an insurance firm, and we meet two or three times either to add extra files or something else," he said. "We have never had a claim yet; sometimes we pay a penalty at the end of the year, sometimes we get a refund."

Barber made clear he is not opposed to workers getting compensated under the program, saying he believes it is "very needed for the ability to support their families at important times."

The WCRI CompScope Medical Benchmarks for Illinois study examined medical payments, prices and utilization in Illinois compared with 17 other states.

Other findings include, according to the study:

"Physical medicine was a key driver of higher-than-typical medical utilization, accounting for more visits per claim and services per visit in Illinois than in other states studied.

"Payments per claim for surgery (professional services) and facility payments to ambulatory surgery centers were higher in Illinois than in other study states.

"Prices paid for professional (nonhospital) services were lower than typical for evaluation and management (office visits), but higher for other services. These results were related to fee schedules."

The Cambridge, Massachusetts-based WCRI is an independent, nonprofit research organization.